Provider Demographics
NPI:1134258874
Name:BAKER, MATTHEW JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:BAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 DEPOT ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2629
Mailing Address - Country:US
Mailing Address - Phone:860-274-9315
Mailing Address - Fax:
Practice Address - Street 1:51 DEPOT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2629
Practice Address - Country:US
Practice Address - Phone:860-274-9315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist